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UNICEF Interventions
for Cholera Prevention
and Control
UNICEF
Initiative Against Diarrheal and
Enteric Diseases Meeting
6 – 9 March 2017
Hanoi, Vietnam
Session Outline U
NIC
EF
INT
ER
VE
NT
ION
S
UNICEF’s integrated approach to preventable diseases
Global WASH Initiatives for cholera prevention and control
Issues and Challenges
WASH Coverage Trends
SDG implications on WASH
The world has missed the MDG Sanitation Target
and in 47 countries, areas and territories, less than
half the population use improved sanitation
but the MDG target for drinking water has been
met
with less than half the population in Africa and
Oceania using improved water
SDG 6: Ensure availability and sustainable management of
water and sanitation for all
6.BLocal
participation
Means of Implementation
Target 6.1 Drinking water
By 2030, achieve universal and equitable access to safeand affordable drinking water for all
6.1.1: Population using safely managed drinking water services
Definition: Pop. using an improved drinking water source which is:
• located on premises,
• available when needed, and
• free of faecal and priority chemical contamination
Lead: WHO/UNICEF Joint Monitoring Programme
Accessibility
Availability
Quality
MDG/SDG Service ladder Progressive realizationSD
G 6
.1 Safely managed drinking water
Improved facility located on premises, available when needed, and free from contamination
MD
Gco
nti
nu
ity
Basic waterImproved facility within 30 minutes round trip collection time
Unimproved water
Unimproved facility does not protect against contamination
No service Surface water
9
Pro
gre
ssiv
eR
ealisati
on
Example of Safely Managed Drinking Water
70
56
49
56
28 28
0
20
40
60
80
100
Population usingimproved water
sources
Population usingbasic drinking
water
Population usingimproved on
premises
Population usingimproved
available whenneeded
Population usingimproved free ofcontamination
Population usingsafely-manageddrinking water
services
Elements of safely-managed
Target 6.2 Sanitation
By 2030, achieve access to adequate and equitablesanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
6.2.1: Population using safely managed sanitation services including a handwashing facility with soap and water
Definition: Pop. using an improved sanitation facility which is:
• not shared with other households and where
• excreta are safely disposed in situ or
• transported and treated off-site
Accessibility
Quality
12
MDG/SDG Service ladder Progressive realizationSD
G 6
.2
Safely managed sanitation
Private improved facility where faecal wastes are safely disposed on site or transported and treated off-site; plus a handwashing facility with soap and water
MD
Gco
nti
nu
ity
Basic sanitationPrivate improved facility which separates excreta from human contact
Shared sanitation Improved facility shared with other hh
Unimproved sanitationUnimproved facility does not separate excreta from human contact
No service Open defecation
Pro
gre
ssiv
eR
ealisati
on
Example of Safely Managed Sanitation
0
20
40
60
80
100
Population usingimprovedsanitation
Population usingimproved onsite
Safely-disposedon site or treated
offsite
Population usingimproved piped to
sewer
Safely transportedand treated off
site
Population usingsafely-managed
sanitationservices
OffsiteOnsite
Open Defecation
Countries that account for almost three-quarters of the people who practice open defecation:
• India 626 million• Indonesia 63 million• Pakistan 40 million• Ethiopia 38 million• Nigeria 34 million• Sudan 19 million• Nepal 15 million• China 14 million• Niger 12 million• Burkina Faso 9.7 million• Mozambique 9.5 million • Cambodia 8.6 million
Target 6.2 Hygiene
By 2030, achieve access to adequate and equitable sanitation and hygiene for all, and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
Population using safely managed sanitation services including a handwashing facility with soap and water
Standard question in MICS and DHS since 2009
• Observation by survey teams
• Data available from 50+ countries
UNICEF WASH Programme is guided by
The Global Cluster Mechanism as Global
WASH Cluster Lead
To fulfil core accountabilities for
children in emergencies
And ensure regular development and
humanitarian nexus
Cholera is cross cutting across results areas in
UNICEF Global WASH Strategy 2016 -2030
An Integrated approach to cholera
• Externally: close collaboration between UNICEF,
WHO, local governments, implementing
partners, communities and others
• Within UNICEF, between sections:
– WASH
– Health
– Communication for development
– Supply division
• UNICEF part of two regional cholera platforms
Multi-sectorial collaboration is a key component of cholera prevention and control
key pathway to prevent cholera is to ensure that
People have access to and use safe water supply
for drinking
Households, communities, institutions and food
outlets practices safe food hygiene
Infants are exclusively breastfed and if needed
given safe fluids and food
The environment is free from excreta because
people dispose of it safely
People WASH their hands with soap and water at
critical times
Environmental hygiene is adhered to in markets and
other public places
Priority WASH Interventions in emergencies
• Increase water supplies
• Improve quality of water supplied
• Increase access to excreta disposal facilities
• Provide hygiene kits, handwashing facilities or soap, water storage vessels (NFIs)
• Hygiene education/Social Mobilization
• Solid waste collection and disposal
• Reduce vector breeding sites
Preferably follows a rapid or comprehensive WASH assessment
UNICEF Cholera Toolkit: A key resource
The UNICEF cholera toolkit provides practical resources to implement an integrated approach to cholera prevention and control.
The toolkit covers: • WASH• Health• Communication for development
(C4D)
Currently being transferred to GTFCC for a broader ownership
Adding a specific section on OCV
https://www.unicef.org/cholera/index_71222.html
Revised Cholera kits
• UNICEF support WHO in providing cholera kits to governments and partners
• Revised Cholera kits designed in 2015; revised after field testing in 2016
• Process
– 6 kits, with modules
– Available in country in 2017
Central Reference Kit
1) Drugs 2) Renewables 3) Equipment4) Logistics5) Documents
Periphery Kit
1) Drugs2) Renewables 3) Equipment4) Logistics5) Documents
Community Kit
1) Drugs2) Community Care 3) Documents
Hardware Kit
1) Shelter2) Water3) Sanitation4) Support5) Fencing
Investigation Kit
1) Sample collection and RDTs2) Equipment for Transport
Laboratory Kit
1) Laboratory Supplies for 100 samples
OCV Award, Availability and Supply in 2016
Haiti : 1,000,000Malawi: 180,000
Award Available Supplied Available 31 Dec 2016
Emergency Stockpile 2,000,000 2,000,000 1,611,050 388,950
Non-emergency Reserve 4,300,000 3,876,300 1,180,000 2,167,725
6,300,000 5,876,300 2,791,050 2,556,675
Reserve Sanchol 471,425
Euvichol 1,696,300
UNICEF hosts the OCV stockpile in its supply
division
South Sudan 72,450 Zambia 68,635 Mozambique 425,495 Zambia 293,720 DR Congo 680,750 DR Congo 70,000
1. WASH Strategies
• define specific WASH interventions in various contexts including: emergency response, ongoing preparedness, long term intervention and in conjunction with OCV campaigns.
2. Efficiency of WASH
Interventions
• develop an investment case methodology for WASH intervention and plan for its development;
3. WASH Practices
• formulate recommendations for key WASH practices to be implemented at local level for cholera control
4. Advocacy & funding
• identify evidence-based approaches including essential personnel, material and budget to advocate for WASH interventions in high risk cholera areas
UNICEF Chairing Global Task Force for Cholera
Control WASH working group
Four sub-WASH working groups
Progress so far…
1. Technical briefs developed
Low-cost assays for microbiological monitoring in the field
Designing and implementing a water quality surveillance
scheme
Producing and testing chlorine solutions
Oral rehydration salt preparation
Summary of WASH requirements for health care facilities,
including cholera treatment centers
Summary of practices to prevent cholera transmission in
homes, institutions, public places
2. A study to define “household disinfection”, its feasibility
and effectiveness carried out in collaboration with Tufts
School of Engineering
3. A review of literature conducted by a London School of
Hygiene and Tropical Medicine (LSHTM) MSc student
Health Emergencies Preparedness Initiative (HEPI)
• Post Ebola UNICEF evaluations – need to improve UNICEF preparedness and response to epidemics/pandemics
• Each outbreak requires collective actions from all sectors (beyond health)
• Challenging to navigate technical standards
• UNICEF not starting from scratch
• Identified key diseases, categorized them and developed a “package of support” for each
Category 1
Current epidemics of focus and focus diseases of epidemic/pandemic potential
• Dengue, Yellow Fever, Zika
• Avian Influenza, Pandemic influenza
• Cholera
• Malaria
• Measles
• Meningococcal Disease
• Polio (Non-Vaccine derived)
Category 2
Endemic or epidemic diseases of potential threat/changing pattern
• Hepatitis E
• Leptospirosis
• Novel coronaviruses
• Typhoid fever
• Viral hemorrhagic fever
• West Nile Virus
Category 3
Endemic or epidemic diseases currently affecting a limited geographic area and or posing limited threat
• Diphtheria
• Monkey pox
• Japanese Encephalitis
• Pertussis
• Plague, Seasonal Influenza
• Shigellosis, enterohemorragic E-coli
• Rubella
Disease Categorization
Key support package for disease categories
Full package for category 1 diseases
o Sector guides, notes, institutional guides, C4D tools,
o Disease specific materials requirements and guidance
o Prepositioning of stock, strengthening supply chain
o Assessment
o Surge support
o Funding support
Basic Package for Category 2 diseases
o Disease specific materials requirement and guidance
o C4D Guides
Limited support for category 3 diseases
o Overarching guide
Issues and Challenges
1. WASH related advocacy activities as agreed in GTFCC has
not been implemented
2. Information sharing among members of the WASH WG,
UNICEF regional offices and countries has been minimal
3. WASH response often reactive rather than proactive
4. Spread of outbreak difficult to predict and complicates
pre-positioning of supplies
5. Criteria to trigger WASH response often unclear
6. Areas with good WASH coverage impacted less by the
outbreak and difficult to control once underway
7. Funding of WASH priorities remains a challenge
For more information, please contact
Laure Anquez,
WASH Specialist, UNICEF HQ
email: [email protected]
Anu Paudyal Gautam
WASH Specialist, UNICEF EAPRO
Email: [email protected]
United Nations Children’s Fund
East Asia and Pacific Regional Office
P.O. Box 2-154, Bangkok 10200
Thailand
www.unicef.org
© United Nations Children’s Fund
June 2016
Cover photo © UNICEF